The value of evidence-based medicine to consultant physicians

The role of parental presence in the context of children's medical procedures: a systematic review

BACKGROUND

There are conflicting views and practices regarding whether or not parents should be present at the time of their child's medical procedure. A systematic review was conducted to assess the effects of parental presence in the paediatric treatment room on child, parent and health professional outcomes and to synthesize this body of literature.

METHODS

Based on a comprehensive literature search, studies investigating parental presence in the paediatric treatment room were included in the review if they had a concurrent control group (i.e. a parent-absent group).

RESULTS

A total of 28 studies met inclusion criteria, which included 1256 children with a parent present and 1025 children without a parent present. There were mixed findings regarding the effect of parental presence on measures of child distress and affect, however, studies of lower levels of evidence were more likely to report significant results. Parents who were present during their child's medical intervention were either better off or no different from parents who were absent with regard to their levels of distress and satisfaction. There was no evidence of increased technical complications nor elevated staff anxiety for health professionals attending to children with a parent present as compared to attending to children without their parents.

DISCUSSION

Although parental presence may not have a clear, direct influence on child distress and behavioural outcomes, there are potential advantages for parents. It seems appropriate that clinicians provide parents with the opportunity to be present during their child's painful procedure.

Knowledge and use of evidence-based nutrition: a survey of paediatric dietitians

OBJECTIVE

To survey paediatric dietitians' knowledge and use of evidence-based nutrition (EBN).

DESIGN

Cross-sectional survey using reply-paid questionnaires.

SUBJECTS

Paediatric dietitians in Australian teaching hospitals.

MAIN OUTCOME MEASURES

Age, sex, appointment, clinical practice, research activities; attitudes to, training in and use of EBN; and perceived barriers to use of EBN.

STATISTICAL ANALYSIS

Data were analysed using descriptive statistics (SPSS).

RESULTS

Fifty-nine (86%) of 69 questionnaires were returned. Most (97%) dietitians were women working full-time (63%), mean age 37 years (+/-9 SD). Most (75%) dietitians encountered knowledge gaps less than five times per week and most (87%) questions related to therapy. The majority (95%) performed their own literature searches, less than five times per month. All had access to >or=1 electronic literature databases including Medline (n = 58, 98%), Cochrane Library (n = 44, 75%) and CINAHL (n = 35, 59%). Information sources used most often were Medline and consultation with colleagues. Reported barriers to using EBN were lack of time (n = 53, 90%) or lack of skills for critical appraisal of published articles (n = 51, 86%) or literature searching (n = 48, 81%). While 53 (90%) believed in an evidence-based approach, 43 (73%) either did not practise EBN or rated themselves as beginners.

CONCLUSION

Most dietitians favoured evidence-based practice, but reported lack of time, skills or rapid access to electronic databases as barriers to its practice.